Abdominal wall anatomy, pathology, and intervention

Abstract

A single reason why a surgeon will use ultrasound is the need to further investigate findings obtained through a complete physical examination. Abdominal wall pathology is frequent and not limited to hernias. Multifrequency transducers (7.5-12 MHz) should be used to scan this region since they have better resolution and variable penetration. In the preoperative, perioperative, and postoperative settings, abdominal wall masses and groin pathology require further definition by various imaging modalities. The advances in ultrasonography have made this technology an extremely user-friendly, portable, safe, and economic modality for the surgeon to further investigate various conditions. In this chapter, we describe and correlate normal anatomy with ultrasound findings; we identify common indications for ultrasound investigation such as neoplasias, ventral hernias, and postoperative complications not limited to infection, hematoma, and seromas; we define indications for ultrasound-guided biopsies and placement of catheters, as needed. Furthermore, ultrasound has been increasingly used for the identification of possible presence of bowel adhesions to the abdominal wall, thus providing a safe route of access for the laparoscopic surgeon. Recently, ultrasound has been used to guide aspiration of fluid collections, biopsy of masses, and nerve blocks. In this era of health-care cost containment, ultrasound constitutes an important tool in the surgeon's armamentarium.